U.S. patent application number 13/586236 was filed with the patent office on 2013-02-21 for coaxial guidewire for small vessel access.
The applicant listed for this patent is Richard M. DeMello. Invention is credited to Richard M. DeMello.
Application Number | 20130046203 13/586236 |
Document ID | / |
Family ID | 47713120 |
Filed Date | 2013-02-21 |
United States Patent
Application |
20130046203 |
Kind Code |
A1 |
DeMello; Richard M. |
February 21, 2013 |
COAXIAL GUIDEWIRE FOR SMALL VESSEL ACCESS
Abstract
A coaxial guidewire for use in accessing smaller vessels within
a patient's body, consists of an inner core wire and an outer
hollow wire. The distal end of the inner core wire tapers and
supports a spring coil. The core wire, including the spring coil,
fits within a 25-gauge needle that is used to locate an artery of
the patient. When the needle is removed over the inner core wire,
the outer hollow wire, having a distal end that tapers to the outer
diameter of the spring coil, fits over the inner wire and is
advanced until the distal end of the outer wire meets the spring
coil of the core wire. A dilator and introducer sheath combination
may then be fed over the assembled coaxial guidewire. When the
distal end of the sheath is in the desired position, the dilator
and the coaxial guidewire are removed.
Inventors: |
DeMello; Richard M.; (Stow,
MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
DeMello; Richard M. |
Stow |
MA |
US |
|
|
Family ID: |
47713120 |
Appl. No.: |
13/586236 |
Filed: |
August 15, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61524943 |
Aug 18, 2011 |
|
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Current U.S.
Class: |
600/585 |
Current CPC
Class: |
A61M 2025/09083
20130101; A61M 25/09 20130101 |
Class at
Publication: |
600/585 |
International
Class: |
A61M 25/09 20060101
A61M025/09 |
Claims
1. A coaxial guidewire utilized to introduce a sheath within a
vessel of a human body, the coaxial guidewire comprising: an inner
guidewire, including a spring coil affixed to a distal end of the
inner guidewire, configured to be passed through a needle that is
placed within the vessel of the human body; and a hollow outer
guidewire configured to be advanced over a proximal end of the
inner guidewire and to meet the spring coil affixed to the distal
end of the core wire to produce the coaxial guidewire, wherein the
coaxial guidewire is configured to be utilized to position the
sheath within the vessel of the human body.
2. The coaxial guidewire of claim 1, wherein the needle is a
25-gauge needle.
3. The coaxial guidewire of claim 1, wherein the inner guidewire is
configured to an outer diameter of 0.010 inches or less at a
proximal end and tapers to the distal end.
4. The coaxial guidewire of claim 1, wherein the spring coil
affixed to the inner guidewire distal end has an outer diameter of
0.014 inches or less.
5. The coaxial guidewire of claim 1, wherein the hollow outer
guidewire is configured to an outer diameter of 0.018 inches or
less at the proximal end and tapers to the distal end.
6. The coaxial guidewire of claim 1, wherein the coaxial guidewire
that includes the inner guidewire and the hollow outer guidewire,
has a outer diameter at the proximal end of 0.018 inches and 0.014
inches at the distal end.
7. The coaxial guidewire of claim 1, wherein a dilator and the
sheath are fed over the coaxial guidewire, to introduce and
position the sheath within the vessel, and wherein the coaxial
guidewire and the dilator are removed from the vessel to leave the
sheath within the vessel.
8. The coaxial guidewire of claim 1, wherein the inner guidewire
includes an atraumatic tip at the distal end.
9. The coaxial guidewire of claim 1, wherein the hollow outer
guidewire is covered with a polymer sleeve.
10. The coaxial guidewire of claim 1, wherein the hollow outer
guidewire is a wound stainless steel spring coil.
11. A method to position an introducer sheath in a vessel of a
human body, the method comprising: introducing a distal end of an
inner guidewire through a needle that is inserted within the vessel
of the human body, wherein the inner guidewire includes a spring
coil affixed to the distal end; withdrawing, over the inner
guidewire, the needle from the vessel of the human body; feeding an
outer guidewire over a proximal end of the inner guidewire, wherein
the outer guidewire meets the spring coil affixed to the distal end
of the inner guidewire to produce a coaxial guidewire that is
within the vessel of the human body; advancing a dilator and sheath
combination into the vessel of the human body over the coaxial
guidewire; and removing the coaxial guidewire and the dilator from
the vessel, thereby leaving the sheath within the vessel of the
human body.
12. The method of claim 11, wherein the inner guidewire is
configured to an outer diameter of 0.010 inches or less at a
proximal end and tapers to the distal end.
13. The method of claim 11, wherein the spring coil has an outer
diameter of 0.014 inches or less.
14. The method of claim 11, wherein the needle is a 25-gauge
needle.
15. The method of claim 11, wherein the coaxial guidewire has an
outer diameter of 0.018 inches or less at the proximal end and
tapers at the distal end to an outer diameter of 0.014 inches or
less.
16. The method of claim 11, wherein the outer guidewire is covered
by a polymer sleeve.
17. The method of claim 11, wherein the outer guidewire is
hollow.
18. The method of claim 11, wherein the outer guidewire is a wound
stainless steel spring coil.
19. The method of claim 11, wherein the vessel is an artery.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional
Patent Application Ser. No. 61,524,943, which was filed Aug. 18,
2011, by Richard DeMello for an "Coaxial Guidewire For Small Vessel
Access" and is hereby incorporated by reference.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The invention relates generally to guidewires, and more
particularly, to guidewires for use in accessing small arterial or
venous vessels within a patient's body such as the adult radial
artery or the arteries of a pediatric patient.
[0004] 2. Background Information
[0005] Recent studies have shown that there are benefits associated
with utilizing the radial artery for angiography and other
intravascular medical procedures that have typically been performed
through the femoral artery. See, for example, Duke Clinical
Research Institute article entitled RIVAL Trial Shows Significant
Benefits With Radial Approach of Angiography Report dated Apr. 4,
2011. The known procedures for accessing an artery to conduct a
medical procedure such as angiography, involves placement of a
valved introducer sheath into the artery. The introducer sheath
acts as a conduit to pass various medical devices into and out of
the artery, while preventing significant blood loss. The introducer
sheaths for use with the radial artery approach, which are
typically referred to as "micro access" or "micro puncture" sets,
accept 5 French (0.066 inch outer diameter) or 6 French (0.079 inch
outer diameter) catheters and devices.
[0006] The known procedure to place the introducer sheaths into the
artery begin with the insertion of a 21-gauge (0.032 inch outer
diameter) needle into the artery. A 0.018 inch diameter guidewire
is next passed through the needle and into the artery so that the
distal portion of the guidewire resides at a desired location
within the artery and the proximal portion of the guidewire extends
out of the patient. The needle is then withdrawn from the patient
over the back of the guidewire, leaving the guidewire extending
through the skin and into the artery. Next, a vessel dilator, which
is a hollow plastic tube having an outer diameter that is sized to
closely fit within the introducer sheath's inner diameter, is
placed into the introducer sheath so that the distal end of the
dilator extends slightly beyond the distal end of the sheath. The
extended distal portion of the dilator has an inner diameter
capable of passing over the 0.018 inch guidewire and is smoothly
tapered to an outer diameter that is slightly larger than the
diameter of the guidewire. The sheath/dilator combination is
advanced over the proximal end of the 0.018 inch guidewire and the
tapered dilator end is used to gradually enlarge the vessel access
site to accommodate the introducer sheath. Once the distal end of
the sheath is in place within the vessel, the dilator and the 0.018
inch guidewire are removed from the patient through the inside of
the sheath, leaving the valved introducer sheath as an access point
for inserting other medical devices.
[0007] The 0.018 guidewire is used to support the dilator/sheath
combination as that combination is advanced. The amount of force
required to allow the dilator/sheath combination to advance tends
to bend and kink guidewires of smaller diameters, which prevents
the proper insertion of the introducer sheath. The use of a
21-gauge needle is required to accommodate the 0.018 inch guidewire
and allow the needle to be withdrawn.
[0008] While the insertion procedure works well for access to the
relatively large femoral artery, the size of the needle makes it
difficult to locate the smaller radial artery. The procedure also
makes it difficult to locate either artery in pediatric patients.
The difficulty in locating the smaller vessels with the large
needles results in the patients being subjected to painful needle
sticks followed often by painful movement of the needles.
SUMMARY OF THE INVENTION
[0009] A coaxial guidewire for use in accessing smaller vessels
within a patient's body, such as, for example, arteries in a
pediatric patient or the adult radial artery, consists of an inner
core wire and an outer hollow wire that has an inner diameter sized
to fit over the inner core wire. The inner core wire has an outer
diameter of 0.010 inches and tapers at a distal end. The distal end
of the inner core wire supports a spring coil with an outer
diameter of 0.014 inches. The core wire, including the spring coil,
fits within a 25-gauge needle that is used to locate the artery.
When the needle is removed over the inner core wire, the outer
hollow wire, which has an outer diameter of 0.018 inches for a
majority of its length and a distal end that tapers to the outer
diameter of the spring coil, fits over the inner wire and is
advanced until the distal end of the outer wire meets the spring
coil that is at the distal end of the core wire.
[0010] Once the outer wire is in place over the inner core wire,
the dilator and introducer sheath combination are fed over the
assembled coaxial guidewire. The coaxial guidewire, which has an
outer diameter of 0.018 inches up to a distal end that is 0.014
inches, provides the support necessary to prevent kinking as the
dilator and introducer sheath combination are advanced to a desired
arterial position over the guidewire. When the distal end of the
sheath is in the desired position, the dilator and the coaxial
guidewire are removed via the sheath.
[0011] The use of the coaxial guidewire to position the introducer
sheath in the body allows the use of a 25-gauge needle, which is
significantly smaller than the 21-gauge needle required with
conventional procedures.
BRIEF DESCRIPTION OF THE DRAWINGS
[0012] The invention description below refers to the accompanying
drawings, of which:
[0013] FIG. 1 is an illustration of an assembled coaxial guidewire
constructed in accordance with the invention;
[0014] FIG. 2 is a more detailed illustration of a core guidewire
included in the assembled coaxial guidewire of FIG. 1;
[0015] FIG. 3 is a more detailed illustration of an outer guidewire
included in the assembled coaxial guidewire of FIG. 1; and
[0016] FIG. 4 is a flow chart of the operations of the introduction
procedure.
DETAILED DESCRIPTION OF AN ILLUSTRATIVE EMBODIMENT
[0017] Referring to FIGS. 1-3, a coaxial guidewire 100 includes an
inner guidewire 102 that consists of an elongated solid stainless
steel core wire approximately 60 centimeters in length with an
outer diameter (OD) of approximately 0.010 inches. The core wire
has a gradually tapered distal end 104 of approximately 4
centimeters that provides increased flexibility. A stainless steel
guidewire spring coil 106, having an OD of approximately 0.014
inches and a length of approximately 6 centimeters is affixed over
the distal portion of the guidewire and covers the entire tapered
portion. The proximal end 105 of the spring coil may be attached to
the inner core guidewire by adhesives, welding, brazing or using
any other well known techniques or combinations thereof. As shown
in the drawings, the core guidewire may include an atraumatic tip
107 attached to the distal end of the spring coil 106.
[0018] A hollow outer guidewire 110, which is made from a wound
stainless steel spring coil 112 and covered with a polymer sleeve
114, has an inner diameter that is sized to fit over the inner core
wire 102. The outer guidewire is approximately 40 cm long and with
the sleeve has an OD of approximately 0.018 inches over the
majority of its length. A distal end portion 116 of the outer
guidewire tapers to the size of the OD of the spring coil 106 that
covers the distal end 104 of the inner core guidewire 102. The
tapered distal end 116 of the outer guidewire thus tapers to an OD
of approximately 0.014 inches. When the outer guidewire is advanced
over the inner guidewire core to meet the distal end of the inner
guidewire, the assembled device 100 functions essentially as a
single guidewire that has a tapered distal end with a 0.14 inch OD
and otherwise has a 0.018 inch OD over the majority of the length
of the assembled guidewire.
[0019] The coaxial guidewire 100 is utilized to insert an
introducer into small vessels and operates with a 25-gauge needle
(0.020 inch OD), which is significantly smaller in diameter than
the 21-gauge needle (0.032 inch OD) required for the conventional
introducer sheath insertion procedure. Referring now also FIG. 4,
the insertion procedure utilizing the coaxial guidewire 100 starts
with the location of the artery with a 25-gauge needle (not shown)
(Step 400). Next, the inner core guidewire 102, which has a 0.014
inch OD at the distal end with the spring coil 106 attached, is
passed through the 25-gauge needle and advanced into the artery
until a distal portion of the guidewire resides within the artery
and a proximal portion of the core guidewire extends outside of the
patient (Step 402). The needle is then withdrawn from the patient
over the back of the 0.014 inch OD core guidewire 102 (Step
404).
[0020] The outer guidewire 110 is next fed over the proximal end
107 of the core guidewire 102 and advanced into the vessel until
the distal end 111 of the outer guidewire meets the spring coil 106
that covers the tapered distal end 104 of the core guidewire 102,
to assemble the coaxial guidewire 100 as depicted in FIG. 1 (Step
406). A dilator (not shown) is fed into an introducer sheath (not
shown) in a conventional manner that is well understood by those
skilled in the art, and the dilator/sheath combination is then
advanced over the coaxial guidewire 100, until a distal portion of
the sheath resides at a desired location within the vessel (Step
408). With the distal portion of the sheath in place in the vessel,
the dilator and the coaxial guidewire 100 are removed from the body
through the sheath (Step 410).
[0021] The use of the smaller gauge needle, that is, the 25-gauge
needle as opposed to the 21-gauge needle, results in a less painful
insertion procedure, and in particular, in reduced pain during the
location of the artery using the needle. Further, the assembled
coaxial guidewire, which has a 0.018 OD over much of its length and
is a combination of a stainless steel core wire and an elongated
outer spring coil, is appropriately sized and has sufficient
strength and resilience to prevent the coaxial guidewire from
bending and kinking as the sheath/dilator combination is advanced
over the assembled coaxial guidewire into the artery.
[0022] The foregoing description has been directed to a specific
embodiment of this invention. It will be apparent, however, that
other variations and modifications may be made to the described
embodiments, with the attainment of some or all of their
advantages. For instance, it is expressly contemplated that the
assemblies, systems, and materials described herein may be
implemented in various forms. Furthermore, in alternate
embodiments, the coaxial guidewire may include additional guidewire
components with appropriately sized inner and outer diameters
and/or the core guidewire component of the coaxial guidewire may be
sized to be utilized with smaller gauge needles. The spring coil
106 covering the distal end of the core guidewire may be longer or
shorter, and may but need not be made of radiopaque material. The
outer surface of either or both of the inner and outer guidewires
may be covered with a lubricious coating, to reduce friction.
Either or both of the inner and outer guidewires may be made from
kink-resistant material, such as nickel-titanium or cobalt alloys.
In addition, either or both of the distal end spring coil and the
outer guidewire spring coil may be made from round coiling wire or
flat coiling wire. Further, either or both of the distal end and
outer guidewire spring coils may be made from nickel titanium or
cobalt alloy wire. Accordingly, this description is to be taken
only by way of example and not to otherwise limit the scope of the
invention.
* * * * *